Tuberculin in diagnosis and treatment : a text-book of the specific diagnosis and therapy of tuberculosis for practitioners and students / By Dr. Bandelier ... and Dr. Roepke.
- Bandelier, B. (Bruno), 1871-1924.
- Date:
- 1913
Licence: Public Domain Mark
Credit: Tuberculin in diagnosis and treatment : a text-book of the specific diagnosis and therapy of tuberculosis for practitioners and students / By Dr. Bandelier ... and Dr. Roepke. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
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![thousand times) by the suggestion of anaphylaxis as being en- tirely misguided. The repetition and increase of dose for diagnosis is correct and necessary. _. J.. In this connection it must be carefully borne Precautions . • , , , r n i i in mind that the following dose may only in net easing ^ rajsecj when the previous one has pro- pose, duced no rise of temperature. If the tem- perature has clearly risen, even by a few tenths of a degree, the dose must not be increased, but the same one repeated after the temperature has fallen quite to normal. (See Charts 5 and 6.) The maxim to increase the dose onlv when the preceding one has been altogether without reaction is of importance in more than one direction. Firstly, it protects from the tuber- culin danger, which, if it occur now at all, is only observed by those who do not adhere to this simple and easily carried out rule. Secondly, the increasingly severe reaction after the repetition of the same dose is, according to Koch [86], a phenomenon specially characteristic of the action of tuberculin, and mav be regarded as an infallible indication of the presence of tuberculosis. Finally, in doubtful cases it may be taken as characteristic of a negative result when a slight rise of tem- perature disappears or is less marked after repetition of the same dose, and still more so after the next larger one. It may then be taken as an axiom : Only increase the dose when the preceding injection has been borne without reaction; otherwise repeat the same dose. The acutest discussion centres round the Maximal Dose. „• r +1 ■ 1 1 • +u a~ ^ question of the maximal dose, i.e., the dose which, if borne without reaction, demonstrates the absence of tuberculosis. Koch [89], fixed the limiting dose at 10 c.mm., which, for greater certainty, he was in the habit of giving twice; when no reaction results he held himself justified in assuming that no recent or progressive tubercle was present. On the ground of some hundreds of observations, we are content with a single maximal dose of 10 c.mm., others with one of 6 or of 5 c.mm., and even this is held by some to be too large. We cannot, then, yet speak of a generally accepted limiting dose with which the tubercular subject must react and the non-tubercular can not. It is more than doubtful whether such a limit could ever be determined with mathematical exactness. The occurrence of the tuberculin reaction as a biological phenomenon depends on the ability of the organism to react, and this again on the general constitution and on the local conditions for reaction present at](https://iiif.wellcomecollection.org/image/b21229351_0096.jp2/full/800%2C/0/default.jpg)
